Page 11 - 2024 Employee Benefits Guide

Prescriptions that are not maintenance medications
You can fill prescriptions that are not maintenance medications at any
retail pharmacy or through Express Scripts’ mail order program for the
applicable copayment.

Mail order prescriptions
The mail order program can be used to fill any prescription. To receive
your medications through the mail, ask your physician to write a
prescription for the appropriate supply (90-day supply for maintenance
medication or 30-day supply for other types of medication), with refills
(as appropriate) and to send it to Express Scripts. Otherwise, obtain a
mail order form from Express-Scripts.com and follow the instructions
for mailing your prescription and copayment to Express Scripts. Once
processed, Express Scripts will mail your medication to your home.
Prescription medication tiers

Express Scripts categorizes prescription medication as Tier 1 (Generic),
Tier 2 (Preferred Brand), or Tier 3 (Non-preferred Brand). The cost of
the medication is not a primary factor in its tier classification. A
medication’s classification may change periodically. You can find
up-to-date prescription medication tiers on Express-Scripts.com,
by using the Express Scripts mobile app, or by contacting Express
Scripts’ customer service.
Prescription copayments

Network Pharmacy Smart90 Rx
Benefit Specialty (at Walgreens) Non-Network Pharmacy
Pharmacy Mail Order

Supply Limitation 30 Day 90 Day 30 Day
Tier 1 (Generic) $10 $20 $10 + 20% of negotiated price

Tier 2 (Preferred Brand) $40 $85 $40 + 20% of negotiated price

Tier 3 (Non-preferred Brand) $60 $125 $60 + 20% of negotiated price

Generic vs. brand-name prescription medications
When a medication is available in generic form (Tier 1), but your
physician prescribes the brand-name medication (Tier-2 or Tier-3), you’ll
be charged the generic copayment plus the difference in cost between
the generic and brand-name medication.
If you request a brand-name drug when the physician approves an
available generic drug, you’ll be charged the brand copay plus the
difference in cost between the prescribed brand-name medication and
its generic (Tier-1) equivalent.

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